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Gepubliceerd in: Huisarts en wetenschap 9/2013

01-09-2013 | Beschouwing

Diagnostiek en beloop van cystitis bij gezonde niet-zwangere vrouwen

Auteurs: dr. Bart Knottnerus, dr. Eric Moll van Charante, dr. Suzanne Geerlings, dr. Gerben ter Riet

Gepubliceerd in: Huisarts en wetenschap | Uitgave 9/2013

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Samenvatting

Knottnerus BJ, Moll van Charante EP, Geerlings SE, Ter Riet G. Diagnostiek en beloop van cystitis bij gezonde, niet-zwangere vrouwen. Huisarts Wet 2013;56(9):444-7.
Terwijl men in veel wetenschappelijke onderzoeken slechts één test onderzoekt gebruiken huisartsen in de praktijk meer vragen en urineonderzoeken, die vaak overlappende informatie bevatten. Als we rekening houden met deze onderlinge afhankelijkheid, dan blijkt dat het stellen van drie vragen vaak voldoende is om een cystitis aan te tonen of uit te sluiten en dat zowel sediment- als dipslide-onderzoek weinig toevoegt aan informatie die al bekend is uit de anamnese en eventueel urinestickonderzoek. Daarnaast blijkt meer dan eenderde van de vrouwen met cystitisklachten bereid te zijn om behandeling met antibiotica uit te stellen als hun huisarts dat voorstelt. Het ter sprake brengen van uitgesteld antibioticagebruik kan dus leiden tot een beperking van het antibioticagebruik en daardoor bijdragen aan het tegengaan van bacteriële resistentieontwikkeling. Omdat de kans op pyelonefritis na een cystitis zeer klein is, is het veilig om antibiotica achterwege te laten. Bovendien is de kans op vermindering van klachten bij een uitgesteld recept even groot als bij het onmiddellijk starten van antibiotica. Hoewel de resultaten voor de onderzochte populatie overtuigend zijn, is voor het doen van hardere aanbevelingen vervolgonderzoek nodig.
Literatuur
1.
go back to reference Knottnerus BJ. Uncomplicated urinary tract infections in general practice [proefschrift]. Amsterdam: Universiteit van Amsterdam, 2012. Knottnerus BJ. Uncomplicated urinary tract infections in general practice [proefschrift]. Amsterdam: Universiteit van Amsterdam, 2012.
2.
go back to reference Kass EH. Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic. AMA Arch Intern Med 1957;100:709–14.PubMedCrossRef Kass EH. Bacteriuria and the diagnosis of infections of the urinary tract; with observations on the use of methionine as a urinary antiseptic. AMA Arch Intern Med 1957;100:709–14.PubMedCrossRef
3.
go back to reference Stamm WE, Counts GW, Running KR, Fihn S, Turck M, Holmes KK. Diagnosis of coliform infection in acutely dysuric women. N Engl J Med 1982;307:463–8.PubMedCrossRef Stamm WE, Counts GW, Running KR, Fihn S, Turck M, Holmes KK. Diagnosis of coliform infection in acutely dysuric women. N Engl J Med 1982;307:463–8.PubMedCrossRef
4.
go back to reference Arav-Boger R, Leibovici L, Danon YL. Urinary tract infections with low and high colony counts 2 young women. Spontaneous remission and singledose vs multiple-day treatment. Arch Intern Med 1994;154:300–4.PubMedCrossRef Arav-Boger R, Leibovici L, Danon YL. Urinary tract infections with low and high colony counts 2 young women. Spontaneous remission and singledose vs multiple-day treatment. Arch Intern Med 1994;154:300–4.PubMedCrossRef
5.
go back to reference Fairley KF, Birch DF. Detection of bladder bacteriuria in patients with acute urinary symptoms. J Infect Dis 1989;159:226–31.PubMedCrossRef Fairley KF, Birch DF. Detection of bladder bacteriuria in patients with acute urinary symptoms. J Infect Dis 1989;159:226–31.PubMedCrossRef
6.
go back to reference Fihn SD, Johnson C, Stamm WE. Escherichia coli urethritis in women with symptoms of acute urinary tract infection. J Infect Dis 1988;157:196–9.PubMedCrossRef Fihn SD, Johnson C, Stamm WE. Escherichia coli urethritis in women with symptoms of acute urinary tract infection. J Infect Dis 1988;157:196–9.PubMedCrossRef
7.
go back to reference Kunin CM, White LV, Hua TH. A reassessment of the importance of lowcount bacteriuria in young-women with acute urinary symptoms. Ann Intern Med 1993;119:454–60.PubMedCrossRef Kunin CM, White LV, Hua TH. A reassessment of the importance of lowcount bacteriuria in young-women with acute urinary symptoms. Ann Intern Med 1993;119:454–60.PubMedCrossRef
8.
go back to reference Osterberg E, Hallander HO, Kallner A, Lundin A, Svensson SB, Aberg H. Female urinary tract infection in primary health care: bacteriological and clinical characteristics. Scand J Infect Dis 1990;22:477–84.PubMedCrossRef Osterberg E, Hallander HO, Kallner A, Lundin A, Svensson SB, Aberg H. Female urinary tract infection in primary health care: bacteriological and clinical characteristics. Scand J Infect Dis 1990;22:477–84.PubMedCrossRef
9.
go back to reference European Confederation of Laboratory Medicine (ECLM). European urinalysis guidelines. Scand J Clin Lab Invest Suppl 2000;231:1–96. European Confederation of Laboratory Medicine (ECLM). European urinalysis guidelines. Scand J Clin Lab Invest Suppl 2000;231:1–96.
10.
go back to reference Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002;287:2701–10.PubMedCrossRef Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002;287:2701–10.PubMedCrossRef
11.
go back to reference Medina-Bombardo D, Segui-Diaz M, Roca-Fusalba C, Llobera J. What is the predictive value of urinary symptoms for diagnosing urinary tract infection in women? Fam Pract 2003;20:103–7.PubMedCrossRef Medina-Bombardo D, Segui-Diaz M, Roca-Fusalba C, Llobera J. What is the predictive value of urinary symptoms for diagnosing urinary tract infection in women? Fam Pract 2003;20:103–7.PubMedCrossRef
14.
go back to reference Lachs MS, Nachamkin I, Edelstein PH, Goldman J, Feinstein AR, Schwartz JS. Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection. Ann Intern Med 1992;117:135–40.PubMedCrossRef Lachs MS, Nachamkin I, Edelstein PH, Goldman J, Feinstein AR, Schwartz JS. Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection. Ann Intern Med 1992;117:135–40.PubMedCrossRef
15.
go back to reference Knottnerus BJ, Geerlings SE, Moll van Charante EP, Ter Riet G. Acute uncomplicated urinary tract infections: towards a simple diagnostic index. Ann Fam Med, in press. Knottnerus BJ, Geerlings SE, Moll van Charante EP, Ter Riet G. Acute uncomplicated urinary tract infections: towards a simple diagnostic index. Ann Fam Med, in press.
16.
go back to reference Cook NR. Statistical evaluation of prognostic versus diagnostic models: beyond the ROC curve. Clin Chem 2008;54:17–23.PubMedCrossRef Cook NR. Statistical evaluation of prognostic versus diagnostic models: beyond the ROC curve. Clin Chem 2008;54:17–23.PubMedCrossRef
17.
go back to reference Little P, Turner S, Rumsby K, Jones R, Warner G, Moore M, et al. Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women. Br J Gen Pract 2010;60:495–500.PubMedCrossRef Little P, Turner S, Rumsby K, Jones R, Warner G, Moore M, et al. Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women. Br J Gen Pract 2010;60:495–500.PubMedCrossRef
18.
go back to reference McIsaac WJ, Moineddin R, Ross S. Validation of a decision aid to assist physicians in reducing unnecessary antibiotic drug use for acute cystitis. Arch Intern Med 2007;167:2201–6.PubMedCrossRef McIsaac WJ, Moineddin R, Ross S. Validation of a decision aid to assist physicians in reducing unnecessary antibiotic drug use for acute cystitis. Arch Intern Med 2007;167:2201–6.PubMedCrossRef
19.
go back to reference Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract 2002;52:729–34.PubMed Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract 2002;52:729–34.PubMed
20.
go back to reference Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ. Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care 2007;25:49–57.PubMedCrossRef Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ. Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care 2007;25:49–57.PubMedCrossRef
21.
go back to reference Richards D, Toop L, Chambers S, Fletcher L. Response to antibiotics of women with symptoms of urinary tract infection but negative dipstick urine test results: double blind randomised controlled trial. BMJ 2005;331:143.PubMedCrossRef Richards D, Toop L, Chambers S, Fletcher L. Response to antibiotics of women with symptoms of urinary tract infection but negative dipstick urine test results: double blind randomised controlled trial. BMJ 2005;331:143.PubMedCrossRef
22.
go back to reference Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ 2010;340:c199.PubMedCrossRef Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ 2010;340:c199.PubMedCrossRef
23.
go back to reference Knottnerus BJ, Geerlings SE, Moll van Charante EP, Ter Riet G. Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: a prospective cohort study. BMC Fam Pract 2013;14:71.PubMedCrossRef Knottnerus BJ, Geerlings SE, Moll van Charante EP, Ter Riet G. Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: a prospective cohort study. BMC Fam Pract 2013;14:71.PubMedCrossRef
24.
go back to reference Leydon GM, Turner S, Smith H, Little P. Women’s views about management and cause of urinary tract infection: qualitative interview study. BMJ 2010;340:c279.PubMedCrossRef Leydon GM, Turner S, Smith H, Little P. Women’s views about management and cause of urinary tract infection: qualitative interview study. BMJ 2010;340:c279.PubMedCrossRef
25.
go back to reference Bleidorn J, Gágyor I, Kochen MM, Wegscheider K, Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection? – results of a randomized controlled pilot trial. BMC Med 2010;8:30.PubMedCrossRef Bleidorn J, Gágyor I, Kochen MM, Wegscheider K, Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection? – results of a randomized controlled pilot trial. BMC Med 2010;8:30.PubMedCrossRef
26.
go back to reference Gágyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J. Immediate versus conditional treatment of uncomplicated urinary tract infection – a randomized-controlled comparative effectiveness study in general practices. BMC Infect Dis 2012;12:146.PubMedCrossRef Gágyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J. Immediate versus conditional treatment of uncomplicated urinary tract infection – a randomized-controlled comparative effectiveness study in general practices. BMC Infect Dis 2012;12:146.PubMedCrossRef
Metagegevens
Titel
Diagnostiek en beloop van cystitis bij gezonde niet-zwangere vrouwen
Auteurs
dr. Bart Knottnerus
dr. Eric Moll van Charante
dr. Suzanne Geerlings
dr. Gerben ter Riet
Publicatiedatum
01-09-2013
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Huisarts en wetenschap / Uitgave 9/2013
Print ISSN: 0018-7070
Elektronisch ISSN: 1876-5912
DOI
https://doi.org/10.1007/s12445-013-0231-y

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